experts: can leaks cause titration pressure to be wrong?

I was just wondering about how pressures are averaged..

I recall seeing my very first summary where my pressure would go up to nineteen and stay there for a long time..

I was sleeping through some very massive leaks..

My question is, would the pressures going up during these leaks cause the summary average pressure to be higher?

If that is true, would you not then end up with a very skewed average pressure?

edit: QUESTION FOR EXPERTS: sorry I needed to bump this, but Im trying to solve this mystery, thanks for your help!
I had a bunch of huge leaks when I got my first summary back, pressures up to almost twenty.. with my average about ten/eleven..

so I thought my pressure was about nine or ten or eleven..

now if I dont leak, I can put my apap on cpap at 4 cm and get less than one ahi.. so question, was my "titration pressure" completely wrong due
to leaks?"

I think it depends on how a particular machine responds to leaks, but in general, I think the answer is yes. If you are leaking, the machine has to work extra hard to try to maintain the pressure you need and it will eventually raise the pressure (I think one brand actually lowers it first just to see if the leak will seal itself).

I also don't think you can trust the AHI data if there are large leaks.

Well mine would raise the pressure to almost twenty, so I was wondering if that twenty made my average go up?

I mean how do you know if you were ever titrated properly if you had massive leaks if those raise your average pressure..

(I was never titrated in a lab, just at home in one position for a week)


is the average pressure supposed to be thought of as your titration pressure?

sorry for the bump, big question is in first post now, trying to solve a mystery about titration pressure being wrong.. thanks!

What is a "bump"?

If your leak rate isn't under control, neither is your Sleep Apnea treatment, PERIOD. The data will be wrong, and the treatment will be too. Keep your leak rate under control, under 38 LPM on remstars is nice! Jim

Bumping a thread on a forum is about when you see something hasn't been responded to in a while but needs attention - even if you don't know the answer - you can bring it to everyone else's attention (bumping it back to the head of the line) by replying with a one-word (or more) response such as "bump" or something else).

Yup, today's CPAPs can and do compensate for Leaks up to a point. I imagine that it may well vary by manufacturer how much leak can be compensated for before the rest of the night's data is skewed and unreliable. But the fact of the matter is that large leaks can and do affect the accuracy of your data AND your reported auto titrated pressure.

thank you! this is really helping me get to the bottom of my mystery.. as to why I only need four cm of pressure..

I guess all my averages were much higher because of the leaks..

I thought it was because i had super positional apnea, just on my back..

Now, I will try four cm on my back all night and see what happens.. if I only need four cm on my back too, I will know that the titration numbers
were completely skewed.. Im so glad I have an auto! I would never have known I could get away with four cm!

thank you so much your help, I do so appreciated it!

elena

Sleep studies should be done with patient's own FITTING mask in order to be reliable--IMHO.

Elena, if, hypothetically, you only need 4cm on your back, what will your conclusion be? Will you conclude you don't need CPAP at all?

Yep, your titration does sound completely out of whack if you were having big leaks.

If you find you only need 4 cm on your back too, can I suggest that you try to find a HOME sleep test (an accredited one) to test you at home, in your own sleeping conditions, without CPAP, to find out if you need it or not before you make a decision whether or not to stop using CPAP?

You may have totally skewed data from the initial sleep lab test, but it seems to me you had very little sleep during that test. The only way to be sure if you need CPAP or not is to have a good test at home in your own bed.

Janknitz wrote:Yep, your titration does sound completely out of whack if you were having big leaks.

If you find you only need 4 cm on your back too, can I suggest that you try to find a HOME sleep test (an accredited one) to test you at home, in your own sleeping conditions, without CPAP, to find out if you need it or not before you make a decision whether or not to stop using CPAP?

You may have totally skewed data from the initial sleep lab test, but it seems to me you had very little sleep during that test. The only way to be sure if you need CPAP or not is to have a good test at home in your own bed.

my new dme has an at home sleep test, its only three hundred dollars.. My doctor offered another sleep test in the hospital, but that costs
thousands.. so an at home sleep test would tell me more than just sleeping with the apap?

I think maybe I should try this!

SleepingUgly wrote:Elena, if, hypothetically, you only need 4cm on your back, what will your conclusion be? Will you conclude you don't need CPAP at all?

I think I might conclude I need four cm to be my titration pressure on my apap.. I know a lot of people cant breath with that, but I have to tell you,
when I put my nasal pillows on, sometimes for awhile I forgot to turn the machine on, and Im just breathing thru the little vent holes, and it
takes me a few minutes to notice that! OMG! So I think Im a pretty shallow breather..

chunkyfrog wrote:Sleep studies should be done with patient's own FITTING mask in order to be reliable--IMHO.

good point! my titration was at home, and I didnt know what I was doing, I think it was mostly a disaster..

thanks so much for your input.. something has just been screwy about my therapy since I started this in february.. but I think Im going to figure
it out soon thanks to you guys!

Are you tired with 4cm of CPAP?

I can tell you that as the "guard on duty", when Mike is having a restless night and I wake to find him having some apneas with large leaks for quite awhile before it wakes me and I adjust his mask, his AHI is still low and does not show events that I KNOW happened at the time he was having those LLs. The LL shows on the graph but does not show any events for that time period. I also observe that his pressure is high enough to prevent apneas if he's on his back for awhile. And just for a little "rant", dear hubby sleeps through the whole episode!